Cross-cultural validation into Portuguese of a questionnaire to assess computer vision syndrome in workers exposed to digital devices / Validação intercultural em português de um questionário para avaliar a síndrome visual do computador em trabalhadores expostos a dispositivos digitais

ABSTRACT Purpose: As digital devices are increasingly used at work, valid and reliable tools are needed to assess their effect on visual health. This study aimed to translate, cross-culturally adapt, and validate the Computer Vision Syndrome Questionnaire (CVS-Q©) into Portuguese. Methods: A 5-phase process was followed: direct translation, synthesis of translation, back-translation, consolidation by an expert committee, and pretest. To run the pretest, a cross-sectional pilot study was conducted with 26 participants who completed the prefinal Portuguese version of the CVS-Q© and were asked about difficulties, comprehensibility, and suggestions to improve the questionnaire. To evaluate the reliability and validity of the Portuguese version of the CVS-Q©, a cross-sectional validation study was performed in a different sample (280 workers). Results: In the pretest, 96.2% had no difficulty in completing it, and 84.0% valued it as clear and understandable. CVS-Q© in Portuguese (Questionário da Síndrome Visual do Computador, CVS-Q PT©) was then obtained. Validation revealed the scale's good internal consistency (Cronbach's alpha=0.793), good temporal stability (intraclass correlation coefficient=0.847; 95% CI 0.764-0.902, kappa=0.839), adequate sensitivity and specificity (78.5% and 70.7%, respectively), good discriminant capacity (area under the curve=0.832; 95% CI 0.784-0.879), and adequate convergent validity with the ocular surface disease index (Spearman correlation coefficient=0.728, p<0.001). The factor analysis provided a single factor accounting for 37.7% of the explained common variance. A worker who scored ≥7 points would have computer vision syndrome. Conclusions: CVS-Q PT© can be considered an intuitive and easy-to-understand tool with good psychometric properties to measure computer vision syndrome in Portuguese workers exposed to digital devices. This questionnaire will assist in making decisions on preventive measures, interventions, and treatment and comparing exposed populations in different Portuguese-speaking countries.

RESUMO Objetivos: À medida que a utilização de equipamentos digitais no emprego aumenta, a avaliação do seu efeito na saúde visual necessita de ferramentas válidas e robustas. Este estudo teve como objetivo traduzir, adaptar culturalmente e validar para português o Questionário da Síndrome Visual do Computador (CVS-Q©). Métodos: O procedimento foi realizado em 5 fases: tradução direta, síntese da tradução, tradução inversa, consolidação por um painel de especialistas, e pré-teste. Para fazer o pré-teste foi realizado um estudo piloto transversal aplicado a uma amostra de 26 participantes que completaram a versão pré-final da versão portuguesa do CVS-Q©, questionando por dificuldades, compreensão e sugestões de melhoria do questionário. Para avaliar a confiança e validade da versão portuguesa do CVS-Q© foi realizado um estudo transversal de validação em uma amostra diferente (280 funcionários). Resultados: No préteste, 96.2% dos participantes não apresentaram dificuldades no preenchimento do questionário, enquanto 84.0% indicaram que era claro e compreensível. Obteve-se, então, o CVS-Q© em português (Questionário da Síndrome Visual do Computador, CVS-Q PT©). A sua validação revelou uma boa consistência interna da sua escala (Cronbach's alpha=0.793), boa estabilidade tem poral (coeficiente de correlação interclasse=0.847; 95% CI 0.764-0.902, kappa=0.839), sensibilidades e especificidades adequadas (78.5% e 70.7%, respetivamente), boa capacidade de discriminação (área abaixo da curva=0.832; 95% CI 0.784-0.879), e uma adequada validade da convergência com o índice de doença da superfície ocular (ocular surface disease index - OSDI; coeficiente de correlação de Spearman=0.728, p<0.001). A análise fatorial revelou um único fator responsável por explicar a variância comum em 37.7%. Um funcionário com uma pontuação ≥7 pontos sofria de síndrome visual do computador. Conclusão: O CVS-Q PT© pode ser considerada uma ferramenta intuitiva, de fácil interpretação e com boas pro priedades psicométricas para avaliar a síndrome visual do computador em funcionários portugueses expostos a ecrãs digitais. Este questionário facilitará as decisões sobre medidas preventivas, intervenções e tratamento, e a comparação entre as populações expostas em diferentes países de língua portuguesa.

Diferencias en los accidentes laborales en España según país de procedencia del trabajador / Differences in occupational accidents in Spain according to the worker's country of origin

OBJETIVO: Comparar los accidentes laborales en trabajadores inmigrantes y autóctonos en España. MATERIAL Y MÉTODOS: La fuente de información procede de la Encuesta Española de Condiciones de Trabajo. La nacionalidad del trabajador fue la variable explicativa principal, clasificada según el índice de desarrollo humano (IDH). La variable resultado fueron los accidentes laborales (AL). Otras variables incluidas fueron sociodemográficas y condiciones de empleo. Se calcularon prevalencias y razones de momios (RM) crudas y ajustadas (regresión logística) con sus intervalos de confianza al 95 por ciento (IC95 por ciento). RESULTADOS: La prevalencia de AL en trabajadores de países de bajo IDH fue 12.7 por ciento (mujeres: 11.1 por ciento), y en españoles 10.3 por ciento (mujeres: 8.1 por ciento). Comparado con trabajadoras autóctonas, las mujeres de países de bajo IDH presentaron mayor riesgo (RM ajustada 1.66; IC95 por ciento 1.21-2.28). Conclusión. Es necesario profundizar en el análisis causal de los AL en inmigrantes identificando los posibles factores de riesgo y reforzando las medidas preventivas para su control.

OBJECTIVE: Compare the occupational accidents between autochthonous and immigrant workers in Spain. MATERIAL AND METHODS: Data were obtained from the Spanish Survey of Working Conditions. Nationality was considered as an explicative variable, and the country of origin was regrouped according to the Human Development Index-HDI. Occupational accidents were the outcome. Other variables included were sociodemographic and employment conditions. Prevalences were calculated as well as simple and adjusted odds ratio (OR) (logistic regression) with a 95 percent confidence interval (CI 95 percent). RESULTS: The prevalence of occupational accidents was 12.7 percent (women, 11.1 percent) for workers from low HDI countries and 10.3 percent (women, 8.1 percent) for Spaniards. A higher risk of occupational accidents was observed among women from low HDI countries compared to Spaniards (adjusted OR 1.66; 95 percentCI 1.21-2.28). DISCUSSION: It is necessary to conduct a more thorough causal analysis of occupational accidents among immigrants in order to identify risk factors and strengthen prevention and control strategies.

Peso al nacer: una comparación de sus factores relacionados entre los recién nacidos de madres españolas y madres colombianas residentes en España / Factors related to birth weight: a comparison of related factors between newborns of Spanish and Colombian immigrant women in Spain

El objetivo del estudio fue establecer diferencias en el peso al nacer (PN) y sus factores relacionados, en recién nacidos (RN) a término de mujeres españolas (Esp) y colombianas (Col) residentes en España, en el periodo 2001-2005. Para ello, se incluyó el total de RN de madres españolas y colombianas a partir del Boletín Estadístico de Nacimientos de España. Según la nacionalidad materna se estimó la asociación del PN (bajo peso -BP-, peso insuficiente -PI- y macrosomía), con variables como intervalo intergenésico, edad materna, número de hijos nacidos vivos, profesión de la madre y sexo del RN. El análisis se basó en el cálculo de frecuencias y la estimación de Odds ratios (OR) simples y ajustadas con intervalos de confianza del 95 por ciento (IC95 por ciento). Se encontró mayor prevalencia de BP en RN de mujeres españolas (3,4 por ciento) que en colombianas (2,1 por ciento). Las madres españolas presentaron mayor riesgo de BP (ORa 1,89; IC95 por ciento 1,65-2,16) y PI (ORa 1,49; IC95 por ciento 1,41-1,57). En las madres colombianas se observó mayor porcentaje de macrosomía (8,0 por ciento). En las niñas de madres españolas se observó mayor porcentaje de BP (Esp 4,1 por ciento; Col 2,7 por ciento) y PI (Esp. 25,6 por ciento; Col. 19,6 por ciento) (p<0,001). Madres con edades >40 años y tener 4 ó más hijos se asoció con el BP para Españolas y Colombianas. Se concluye que los recién nacidos de las madres colombianas presentan menor prevalencia de BP y PI, lo que es compatible con el efecto del inmigrante sano.

The objective of this study is to establish differentials in birth weight (BW) and related factors, in term newborns (NB) of Spanish (SP) and Colombian (CO) immigrant mothers living in Spain, between 2001-2005. Data on the NB population of SP and CO mothers was retrieved from the National Statistical Bulletin of Birth in Spain. We analysed the association with BW (Low birth weight -LBW- insufficient weight -IW- macrosomia), by the nationality of the mother; taking into account variables such as the intergenesic interval, maternal age, number of live children, maternal occupation and sex of NB. The analysis was based on frequencies and the estimation of simple and adjusted odds ratios (OR) by means of logistic regression with 95 percent confidence intervals (95 percent CI). A higher prevalence of LBW was found in SP mothers (3.4 percent) than in their CO counterparts (2.1 percent). In SP mothers a higher risk of LBW (aOR 1.89, 95 percentCI 1.65- 2.16) and IW (aOR 1.49, 95 percentCI 1.51- 1.57) was observed. In CO mothers a higher percentage of macrosomia was found (8.0 percent). Also, a higher percentage of LBW was observed in female new borns (SP 4.1 percent; CO 2.7 percent) as well as IW (PI (SP 25.6 percent; CO 19.6 percent)(p<0.001). Mothers aged >40 years and having 4 or more children were associated with LBW in both nationalities. As a conclusion, NB of Colombian mothers presented a lower prevalence of LBW and IW, which could be explained by the healthy migrant effect.

¿Qué sabemos sobre los factores de riesgo de la fibromialgia?: what do we know about risk factors? [revisión] / Understanding fibromyalgia: What do we know about risk factors? [review]

Objetivo El objetivo de este trabajo es describir las principales características de los artículos publicados en revistas científicas entre los años 1992 y 2007 que aborden el análisis de los factores etiológicos asociados a esta patología. Material y Método Revisión sistemática de artículos científicos sobre esta asociación, utilizando las bases de datos de ciencias de la salud y sociales: Medline, Cinhal, Web of Science, Lilacs, Sociological Abstracts, Cuiden, Embase, PsycoInfo e ISI Web of Knowledge. Resultados Se ha obtenido en el período de estudio 21 artículos, distribuidos así: 7 (33,3 por ciento) revisiones teóricas, 6 (28,5 por ciento) estudios transversales, 4 (19,0 por ciento) estudios de cohortes, 2 (9,5 por ciento) estudios de casos y controles y 1 (4,7 por ciento) revisión sistemática. De éstos, 7 (33,3 por ciento) consideraban como factor de riesgo el estrés, 3 (14,3 por ciento) la hepatitis C, 4 (19,0 por ciento) antecedente traumático, 3 (14,3 por ciento) la ocupación y en 4 (19,0 por ciento) se asoció la aparición a otros factores como los implantes de silicona, el tabaco, los factores sociodemográficos y factores hormonales. El período temporal más productivo fue 2000-2004. Se observa una gran dispersión temática en las revistas de publicación. Discusión La evidencia empírica existente en torno a los factores de riesgo de la fibromialgia es todavía escasa y dispersa. Estudios futuros deberían centrarse en generar más conocimiento sobre los factores de riesgo estudiados, para así poder contribuir a mejorar la atención, diagnóstico y tratamiento de la fibromialgia.

Objective This study was aimed at describing the main features of articles published in scientific journals between 1992 and 2007 addressing the analysis of the etiological factors associated with this condition. Materials and MethodsThis consisted of a systematic review of scientific articles regarding this association using the following health and social science databases: Medline, Cinhal, Web of Science, Lilacs, Sociological Abstracts, Embase, Psycoinfo and ISI web of Knowledge. Results 21 articles were obtained during the study period, distributed as follows: 7 theoretical reviews (33.3 percent), 6 cross-sectional studies (28.5 percent), 4 cohort studies, (19.0 percent) 2 case-control studies (9.5 percent) and 1 systematic review (4.7 percent). Of these, 7 (33.3 percent) considered the following to risk factors to be associated with the emergence of other factors such as silicone implants, socio-demographic and hormonal factors: 3 on stress (14.3 percent), 4 on hepatitis C (19.0 percent), 3 on traumatic antecedents (14.3 percent) and 4 on occupation (19.0 percent). The most productive time was 2000-2004. There was broad thematic dispersion in the published journals. Discussion Available empirical evidence about risk factors related to fibromyalgia is still scarce and scattered. Future studies should focus on generating more knowledge about the risk factors studied so as to help improve fibromyalgia care, diagnosis and treatment.

El debate parlamentario sobre inmigración y salud en España / The Parliamentary debate on immigration and health in Spain

Objetivo Describir y analizar el debate parlamentario español sobre inmigración y salud. Métodos Búsqueda sistemática de las iniciativas parlamentarias (IP) sobre inmigración e inmigración y salud desde el inicio del periodo democrático español en 1979 hasta 2007. Se aplicó un protocolo de recogida de información para identificar las características del debate parlamentario y los principales temas en las IP relacionadas con inmigración y salud. Se calcularon la proporción de IP de inmigración sobre el total de iniciativas y la proporción de población inmigrante sobre la población española por cada año de estudio. Resultados Se identificaron 4 022 IP sobre inmigración en el periodo estudiado. Se destaca la generación de datos estadísticos sobre aspectos que afectan a la población inmigrante (57,2 por ciento). En 116 IP sobre inmigración y salud, destaca la discusión sobre estrategias de atención sanitaria (25 por ciento) y el acceso a servicios de salud (24,1 por ciento). El 94 por ciento de estas IP fueron preguntas correspondientes a la función de control del gobierno. En 113 IP (97,4 por ciento) sobre inmigración y salud no se tomaron decisiones. Junto a la presencia cada vez mayor de población inmigrante por año, no se observan cambios notorios en las IP sobre inmigración hasta el año 1996 y en inmigración y salud hasta 1999. Conclusión El debate sobre inmigración y salud es heterogéneo. Seria conveniente fomentar la discusión sobre estrategias para el fomento de la salud basadas en las necesidades de la población inmigrante.

Objective Describing and analysing the Spanish Parliamentary debate on immigration and health. Methods A systematic search regarding parliamentary initiatives (PI) on immigration and immigration and health was conducted from the beginning of the Spanish democratic period (1979 to 2007). A protocol for collecting information was used to identify the parliamentary debate’s main characteristics and the main topics related to PI concerning immigration and health. The PI immigration rate was calculated regarding the total rate of PI about the immigrant population based on the Spanish population per year. Results 4,022 PI concerning “immigration” were identified. The main content concerned statistical information about the immigrant population (57.2 percent). 116 PI about “immigration and health” were analysed. The most frequently recurring topics were health-care strategies (25 percent), health-service access (24.1 percent) and epidemiological information (19.8 percent). Most PI concerned questions related to the function of government control (94 percent). No decisions were taken in 113 PI (97.4 percent). Immigrant population rates increased per year; however, notable changes in PI regarding immigration were not observed until 1996 and PI about immigration and health until 1999. Conclusion The immigration and health debate on the parliamentary agenda is heterogeneous. It would seem necessary to increase parliamentary debate about strategies and action for promoting immigrant-based needs in health.

Condiciones sociales y de salud de los recicladores de Medellín / Social conditions and health profile of recyclers from Medellín

Objetivo Los recicladores en la ciudad de Medellín (Colombia) son un grupo social de gran tradición que en una gran mayoría han trabajado en sectores informales de la economía. Este estudio tiene como objetivo analizar la situación social y económica, el perfil de morbilidad y las condiciones de acceso a los servicios de salud en una población de recicladores y sus familias. Métodos Estudio descriptivo, mediante encuestas de caracterización socioeconómica en recicladores y familiares (515 personas) y su valoración médica (174 personas). Se describieron las variables estudiadas por edad y sexo. El área de estudio estuvo constituida por los recicladores del sector de Guayaquil (Medellín). Resultados El 71,6 por ciento de la población analizada habita en barrios de estratos medio bajo y bajo, en su mayoría población joven. Se establecen principalmente (83 por ciento) por uniones libres y matrimonios con un promedio de 5,3 ± 2,7 personas por familia. El 42 por ciento viven en situación de pobreza. Se reportan infecciones respiratorias (32,5 por ciento) y diarreicas (10,5 por ciento) y en la valoración médica, se encuentran enfermedades crónicas (47,1 por ciento), entre ellas enfermedades del sistema nervioso y órganos de los sentidos (20,1 por ciento). El 37 por ciento no están cubiertos por un seguro de salud. Conclusiones Se presentan condiciones de vida y de salud deficientes, que requieren soluciones concretas para este grupo que permitan el mejoramiento del nivel social, la generación de empleo, el aumento de la cobertura en salud y la realización de campañas de promoción de la salud y prevención de la enfermedad.

Objective Recyclers in the city of Medellin (Colombia) are social groups having a long-standing tradition; many of them have worked in informal economy sectors. This study was aimed at analysing their economic and social situation, health profile and health service accessibility (i.e. for a recycler group and their families). Methods A descriptive study was carried out by means of socioeconomic characterisation surveys of recyclers and relatives (515) and 174 medical examinations. The variables were described by age and gender. The area being studied was the locality of Guayaquil (Medellín) and its recyclers who accepted participating in the study. Results 71,6 percent of the population being analysed inhabited lower and middle-lower class neighbourhoods; most were young people. The main household organisation consisted of living with a partner and marriage (83 percent), having 5,3 ± 2,7 people per family. 42 percent were living in conditions of poverty (1-2 dollars per day income). Respiratory (32,5 percent) and diarrheic infections (10,5 percent) were reported. Medical examination revealed chronic diseases (47,1 percent), nervous system and sense organ diseases (20,1 percent). 37 percent had no health insurance. Conclusion The recyclers and their relatives were living in deficient social conditions. Public health action for the benefit of this group is required by means of generating employment, increasing health insurance cover and promoting specific health promotion and disease prevention strategies.

Percepción sobre condiciones de trabajo y salud de la población inmigrante Colombiana en Alicante, España / A group of Colombian immigrants' self-perception regarding working conditions and health in Alicante, Spain

Objetivo: Explorar la autopercepción sobre condiciones laborales y salud en inmigrantes colombianos en Alicante, España. Material y método Estudio cualitativo descriptivo mediante 11 entrevistas y 2 grupos de discusión en trabajadores con y sin permiso de trabajo y residencia de más de 6 meses en la provincia de Alicante (España), durante los meses de noviembre de 2006 a enero de 2007. Se realizó análisis narrativo de contenido y se obtuvieron categorías mixtas de acuerdo y disenso. Resultados: La inmigración es entendida como un proyecto para mejorar las condiciones socioeconómicas del trabajador inmigrante y su familia. El reconocimiento social y laboral puede evitar la aparición de fenómenos de exclusión y discriminación. Las personas entrevistadas asociaron sus problemas de salud con sus condiciones de vida, manifestando que constituyen limitaciones para la realización de actividades cotidianas. Conclusiones: La situación laboral y de salud es considerada desde una perspectiva multidimensional, asociada a condiciones biológicas y socioculturales. Sería necesaria una mayor acción política para mejorar la situación económica, laboral y de salud de la población inmigrante.

Objective: Exploring the self-perceptions of a group of migrants from Colombia living in Alicante , Spain , regarding their working conditions and health. Material and methods This was a qualitative and descriptive research was conducted on a group of Colombian workers (with and without legal permission to work) having lived in Alicante ( Spain ) for more than 6 months. 11 interviews were carried out, plus 2 focal groups, from November 2006 to January 2007. The interviews were recorded and transcribed. A narrative analysis of the contents was carried out, a mixture of categories being obtained from different viewpoints. Results: Immigration was understood as being an action for improving an immigrant worker and family's socioeconomic conditions. Work and social recognition should lead to avoiding exclusion and discrimination. The people interviewed had associated their health problems with their living conditions. Such problems were considered to be a limitation on carrying out their daily activities. Conclusions: Working and health situations were perceived from a multi-dimensional perspective associated with biological and socio-cultural conditions. More political action should be taken for improving immigrant people's economic, work and health conditions.